Initial thrombocytopenia as a simple, valuable predictor for clinical manifestation in acute hepatitis A.
OBJECTIVE
Although acute hepatitis A (AH-A) is usually self-limited, the clinical manifestations can vary from mild to severe liver dysfunction. However, little is known about the simple, valuable predictors for clinical manifestation in AH-A. The objective of this study was to identify the simple clinical predictors for severe liver dysfunction and its clinical course.


METHODS
A total of 162 IgM anti-hepatitis A virus (HAV) positive patients were enrolled in the study. Severe AH-A was defined as a prothrombin time <40% of control activity. Various liver-unrelated and liver-related parameters at presentation were compared separately between the severe AH-A group and the non-severe group.


RESULTS
Mean age (+/-SD) was 27.5 (+/-7.1) years and the proportion of males was 54% (88/162). Fourteen patients (8.7%) experienced severe AH-A. Of the liver-unrelated parameters, leukopenia (<4000/microl), thrombocytopenia (<150,000/microl), and high serum C-reactive protein levels (>8 mg/l) at presentation were significant predictors for severe AH-A in a univariate analysis (p<0.05). On multivariate analysis, only thrombocytopenia was an independent predictor for severe AH-A (odds ratio (OR) 5.562, 95% confidence interval (CI) 1.153-26.834, p=0.033). Of the liver-related parameters, there were no independent predictors, as shown by multivariate analysis. The thrombocytopenia group (33%, 54/162) not only had a longer recovery time (28 days (range, 14-140) versus 37 days (20-128), p<0.001), but also more frequent complications (OR 4.632, 95% CI 1.886-11.372, p=0.001) than the non-thrombocytopenia group.


CONCLUSIONS
Initial thrombocytopenia may be a simple, valuable predictor for severity and clinical course in AH-A.
Kim
Hyoung Su
HS
Department of Internal Medicine, Kangdong Sacred Heart Hospital of Hallym University Medical Center, Seoul, Republic of Korea.
Kim
Hee Seon
HS
Lee
Jeong Yoon
JY
Jang
Ji Sun
JS
Shin
Woon Geon
WG
Kim
Kyung Ho
KH
Park
Joon Yong
JY
Lee
Jin Heon
JH
Kim
Hak Yang
HY
Jang
Myoung Kuk
MK
D000208:Acute Disease; D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006506:Hepatitis A / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008297:Male; D011517:Prothrombin Time; D013921:Thrombocytopenia / Q000209:etiology*
D002097:C-Reactive Protein